Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 4239 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 1  |  Page : 153-154
Acute tubular necrosis, acute renal failure and unusual histologic stigmata of acute malaria in HIV/AIDS patients from the democratic Republic of Congo


Department of Pathology, University Hospital of Kinshasa, Democratic Republic of Congo, Congo

Click here for correspondence address and email

Date of Web Publication8-Jan-2010
 

How to cite this article:
Pakasa NM. Acute tubular necrosis, acute renal failure and unusual histologic stigmata of acute malaria in HIV/AIDS patients from the democratic Republic of Congo. Saudi J Kidney Dis Transpl 2010;21:153-4

How to cite this URL:
Pakasa NM. Acute tubular necrosis, acute renal failure and unusual histologic stigmata of acute malaria in HIV/AIDS patients from the democratic Republic of Congo. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Dec 6];21:153-4. Available from: http://www.sjkdt.org/text.asp?2010/21/1/153/58793
To the Editor,

A screening of 43 pre and post-mortem renal specimens from HIV-1/AIDS infected patients "incidentally" revealed unusual presence of stig­mata of acute malaria in five male and seven female (28%). The twelve patients were all hy­potensive and had a depressed renal function (mean serum creatinine 10.7 ± 3.1 mg/dL; BUN 198.2 ± 56.4 mg/dL). 4 had pitting edema. A single patient had nephrotic range proteinuria and another had microscopic hematuria. On his­tologic examination of renal specimens, besides huge amount of malarial material including free merozoites clogging capillary luminae and in tubules, [1],[2] there was also severe acute tubu­lar necrosis (ATN) [Figure 1]A and B in 10 (85%) patients. 2 of these patients had a cla­ssical HIV-associated nephropathy (HIVAN), 1 had a hilar focal and segmental sclerosis, 1 had a global sclerosis, 4 had mesangial hyper­plasia [Figure 1]A and 1 had amyloidosis. All patients died within 5.1 ± 2.1 days from va­rious complications. The synergism of malaria and HIV/ AIDS has not sparked much attention in developing sub-Saharan countries. A study from Zimbabwe showed that HIV infection was significantly associated with development of severe and complicated malaria. [3] Acute renal failure (ARF) occurred in 1.2% cases. A prospective clinical survey of 210 HIV-sero­positive patients from our hospital found ARF in 24 of them (11.4%) and 16% were associa­ted with malaria. The outcome was poor and 91.6% died very shortly after admission. [4] Ano­ther unpublished study from the same depart­ment disclosed 36.8% of ARF to be associated with acute malaria. In poor countries like the Democratic Republic of Congo lacking any re­nal replacement modalities, [5] preventable severe malaria per se may contribute to the high mor­tality from severe ATN-induced ARF. Simul­taneous occurrence of both hyperacute malaria and HIV/AIDS may decrease the chances of survival.

In conclusion, we have documented overwhel­ming morphologic evidence of malaria related renal disease superimposed on and exacerba­ting renal failure in HIV/AIDS cohorts. A high index of suspicion may improve renal and overall survival in such patients.

 
   References Top

1.Pakasa M, Vandamme B, Desmet VJ. Free intraglomerular antigens in experimental malaria. Br J Exp Pathol 1985;66:493-501.  Back to cited text no. 1      
2.Vandamme B, Pakasa M, Desmet VJ. Concepts in the Pathogenesis of malaria nephropathy. Recent advances in pediatric nephrology 1987; 287-292. Elsevier Science Publishers B.V.K. Karakam et al. editors.  Back to cited text no. 2      
3.Chirenda J, Siziya S, Tshimanga M. Association of HIV infection with the development of severe and complicated malaria cases at a rural hospital in Zimbabwe. Cent Afr J Med 2000; 46:5-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Nyimi ML, Lepira FB, Sumaili KE, Ebengo BC, Nseka MN, Longo-Mbenza B. Acute renal failure associated with HIV infection. A report of 24 cases. Louvain Medical 2001;120:167-72.  Back to cited text no. 4      
5.Pakasa N, Sumaili E. The nephrotic syndrome in the Republic Democratic of Congo. N Engl J Med 2006;354:1085-6.  Back to cited text no. 5      

Top
Correspondence Address:
Nestor M Pakasa
Department of Pathology, University Hospital of Kinshasa, Democratic Republic of Congo
Congo
Login to access the Email id


PMID: 20061713

Rights and Permissions


    Figures

  [Figure 1]

This article has been cited by
1 Acute renal failure in Congolese children: A tertiary institution experience
Aloni, M.N. and Nsibu, C.N. and Meeko-Mimaniye, M. and Ekulu, P.M. and Bodi, J.M.
Acta Paediatrica, International Journal of Paediatrics. 2012; 101(11): e514-e518
[Pubmed]
2 Pathological peculiarities of chronic kidney disease in patient from sub-Saharan Africa. Review of data from the Democratic republic of Congo [Particularités anatomopathologiques de la maladie rénale du sujet de læAfrique sub-Saharienne: Revue synthétique des données de la République démocratique du Congo]
Pakasa, N.-M. and Sumaïli, E.-K.
Annales de Pathologie. 2012; 32(1): 40-52
[Pubmed]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    References
    Article Figures
 

 Article Access Statistics
    Viewed1711    
    Printed75    
    Emailed0    
    PDF Downloaded405    
    Comments [Add]    
    Cited by others 2    

Recommend this journal